Week 5.1 Entry

The patient we saw today was progressing very well since we had seen 2/52 ago. She had had a TKR and we were dealing with her return to normal function and reporting back to her surgeon when the time came. She did not believe that she was moving along well at all but we reassured her that she is going very well and on track to having a great recovery from such an invasive operation. In the first week we may not have been able to make this call but with treating 6 patients and dealing with another 10 people in a class designed for those people who have undergone TKRs we felt we were in a good position to offer our opinion on how she was progressing. The patient had also been ill the last few weeks and showed some concern for possible complications such as infection. Our supervisor was able to offer his thoughts on the situation and suggested that the patient mention this to her doctor when she visited him in the next couple of days.

This made me think about all the questions we ask that are designed to clear the possibility of more severe conditions such as infection, cauda equina issues and vertebral artery insufficiencies. At what point does an answer warrant more investigation. For instance we have had many patients who have mentioned losing 5kgs in 2 weeks, dizziness with certain movements or increased frequency of urination. Ultimately most people will lose some weight following surgery thru decreased exercise and food intake, many people get small dizzy spells when moving suddenly etc. Since most of the time the question can appear odd in the context of a musculoskeletal examination, (as we discovered when we asked a 16yo girl about her bowel/bladder function) a patient may begin to worry that there may be something more severe wrong with them. Therefore having a thorough knowledge of the specifics of the question is vital so the patient can be assured that it is simply a routine question. The prevalence of such circumstances may be very low but I’m guessing that at some point in all of our careers we will be faced with dealing with such a situation and it is not something we should disregard at this stage.

At this point in the placement I am feeling very comfortable and confident with treating patients, more so the communication side of things and just making the patient feel comfortable to discuss and trust the treatments which we are applying. I have found that I have developed my ability to explain to patients clearly what is occurring and make them understand what my intention is and how they will progress with time. Also I see that it is very important to build a complete and smooth assessment and treatment process so that the patient can have total confidence in the physiotherapist, as I increase my knowledge base about all the different conditions I imagine this will become second nature to me.

If possible the best option is to plan the process ahead of time and anticipate numerous different scenarios and then deal with the situation as it presents itself. We have learnt this many times with expecting simple situations but been suprised when a patient has many more complicating factors than we could have imagined.